The reason why I mention this subject yet again is the alarming news reported in numerous places (for instance in this article) that measles outbreaks are now being reported from most parts of the world.

The number of cases in Europe is at a record high of more than 41,000, the World Health Organization (WHO) warned. Halfway through the year, 2018 is already the worst year on record for measles in Europe in a decade. So far, at least 37 patients have died of the infection in 2018.

“Following the decade’s lowest number of cases in 2016, we are seeing a dramatic increase in infections and extended outbreaks,” Dr. Zsuzsanna Jakab, WHO Regional Director for Europe, said in a statement. “Seven countries in the region have seen over 1,000 infections in children and adults this year (France, Georgia, Greece, Italy, the Russian Federation, Serbia and Ukraine).”

In the U.S., where measles were thought to be eradicated, the Centers for Disease Control and Prevention has reported 107 measles cases as of the middle of July this year. “This partial setback demonstrates that every person who is not immune remains vulnerable no matter where they live, and every country must keep pushing to increase coverage and close immunity gaps,” WHO’s Dr. Nedret Emiroglu said. 95 percent of the population must have received at least two doses of measles vaccine to achive herd immunity and prevent outbreaks. Some parts of Europe have reached that target, while others are even below 70 percent.

The medical profession is afraid that the benefits of alternative medicine become better known.

I could go on, but I am sure you get the picture.

The amazing thing is that I hear such arguments not just from fanatic proponents of alternative medicine, but also from more reasonable people. These sentiments seem to be entirely common and seemingly logical arguments. Most people I meet seem to believe them at least to some degree.

Having heard them so often, I do wonder: Can one explain alternative medicine as a conspiracy theory?

A conspiracy theory is an erroneous and often difficult to falsify notion that tries to explain a set of circumstances as the result of a secret plot by usually powerful conspirators, while ignoring obvious alternative explanations. The very concept of alternative medicine assumes that there are valuable therapies that conventional healthcare does not allow in its realm.

The reasons for the secret plot that prevents them to be included in conventional healthcare are rarely named by enthusiasts of alternative medicine. So, what are they?

Professional jealousy?

Financial interests?

Lack of interest?

Lack of caring?

According to proponents of alternative medicine who I have asked, they consist of a mixture of all of these possibilities. And all of these possibilities are, in a way, consistent with alternative medicine being based on a conspiracy theory.

When I ask people why they believe in these theories, they cannot produce any solid evidence for their beliefs. This does not surprise me because, as far as I can see, there is no evidence to support them: they are erroneous. In turn, this means that one important criterium for conspiracy theory is being met.

Another characteristic of conspiracy theories is that they cannot easily been proven to be false. None of the above-listed reasons are, in fact, difficult to falsify.

A final characteristic of conspiracy theories is that its proponents are ignoring obvious alternative explanations.

WHY ARE ALTERNATIVE THERAPIES NOT ADMITTED INTO THE REALM OF CONVENTIONAL MEDICINE?

Simply because they are not supported by sufficiently strong evidence for generating more good than harm.

So, yes, to some extent alternative medicine even is a conspiracy theory in disguise.

Two new members have been appointed to the Society’s Public Affairs (PAC) and Professional Standards (PSC) committees for three-year terms of office.

Selina Hatherley RSHom is joining the PAC. She has been a member since 2004 and works in three multi-disciplinary practices in Oxfordshire and previously ran a voluntary clinic working with people with drug, alcohol and mental health issues for 12 years. She has also been involved in the acute trauma clinics following the Grenfell Tower fire in 2017.

New to the PSC is Lynne Howard. She became a RSHom in 1996 and runs a practice in three locations in east London and a major London hospital. She specialises in pregnancy, birth and mother-and-baby issues.

“Following an open and comprehensive appointment process, we are delighted to welcome Selina and Lynne ‘on-board’ as brand-new committee members who will bring new ideas, experiences and knowledge to the society,” said Chief Executive Mark Taylor.

END OF QUOTE

It seems to me that the SoH might be breaching its very own Code of Ethics with these appointments.

1) Lynne Howard BA, LCH, MCH, RSHom tells us on her website that she has been practising homeopathy for 25 years, she has run many children’s clinics and is a registered CEASE practitioner with a special interest in fertility and children’s health.

2) Selina Hatherley has a website where she tells us this: In 2011 I trained as a Vega practitioner – enabling me to use the Vega machine to test for food sensitivity and allergens. I use homeopathic remedies to support the findings and to help restore good health… I am a registered member of the Society of Homeopaths – the largest organisation registering professional homeopaths in Europe, I abide by their Code of Ethics and Practice and am fully insured.

Vega, or electrodermal testing for allergies has been evaluated by the late George Lewith (by Jove not a man who was biased against such things) and found to be bogus. Here are the conclusions of his study published in the BMJ: “Electrodermal testing cannot be used to diagnose environmental allergies.” That’s pretty clear, I think. As the BMJ is not exactly an obscure journal, the result should be known to everyone with an interest in Vega-testing. And, of course, disregarding such evidence is unethical.

But perhaps, in homeopathy, ethics can be diluted like homeopathic remedies?

Vis a vis the overwhelming evidence to the contrary, why are there so many clinicians (doctors as well as lay practitioners) who still believe that homeopathy is working? And why are there so many patients who still believe that homeopathy is working?

These are questions that puzzle me quite a bit.

Of course, there is no simple, single answer; there are probably dozens. But one reason must be that there are only three possible outcomes after homeopathic treatments, all of which are favourable for homeopathy (at least in the interpretation of proponents of homeopathy). Seen in this light, there simply is no better therapy!

Let me explain:

If a patient consults a homeopath who prescribes a highly diluted homeopathic remedy, she might subsequently:

get better,

get worse,

or experience no change at all.

Analysing these three possibilities, we quickly see that, from the point of view of a convinced homeopath, all are a proof for homeopathy’s effectiveness, and none suggests that the scientific evidence is correct in claiming that highly diluted homeopathic remedies are pure placebos.

SCENARIO 1

In this situation, it is easy to assume that the remedy was the cause for the clinical improvement. Most clinicians of any discipline fall into this trap, and most patients follow them willingly. Yet, we all know that a temporal relationship is not the same as a causal one (the crowing of a cock before dawn is not the cause of the sun rising). Of course, it is conceivable that the treatment was the cause, but there are several other possibilities as well; just think of the placebo effect, regression towards the mean, and the natural history of the disease. In our case, these non-specific effects are most certainly the cause of our patient’s improvement.

SCENARIO 2

Most clinicians in this situation would start wondering whether they have employed the correct therapy for this patient’s condition – not so the homeopath! He would triumphantly exclaim: “excellent, you are experiencing a ‘homeopathic aggravation’. This is a sure sign that I have given you the optimal remedy. Things will get better soon.” A homeopathic aggravation occurs, according to homeopathic logic, because homeopathy follows the ‘like cures like’ principle. The homeopath prescribes the remedy that would normally cause the symptoms from which his patient is suffering. This means it must also cause these symptoms in every patient. Usually these aggravations are not strong enough to be noticed, but when they are, it is interpreted by homeopaths as a triumph of homeopathy.

SCENARIO 3

In this situation, the homeopath has several options. He can claim “but without my remedy you would be much worse by now. The fact that you are not, shows how very effective homeopathy really is. A more humble homeopaths might explain that the optimal remedy is not always easy to find straight away, and he would therefore proceed in prescribing another one. In both cases, the patient is kept paying for more and homeopathy is presented as an effective therapy.

These three scenarios clearly show that there is no conceivable outcome where any homeopathy-fan would need to consider that scientists are correct in stating that homeopathy is ineffective. And this is one of the reasons why the myth of homeopathy’s effectiveness persists.

Hold on … the patient might be dead!

Yes, that is a rather unfortunate situation for any clinician – except for a homeopath, of course. He would simply point out that the patient must have forgotten to take her medicine. A conventional practitioner might get in trouble, if he tried that excuse; one could easily measure blood levels of the prescribed drug and verify the claim. Not so in homeopathy! Because they contain not a single active molecule, homeopathic remedies are undetectable!

We can easily see that there is no better treatment than homeopathy – at least for the homeopath!

Chiropractors will never cease to amuse and amaze me. Today, I received this comment to a recent post of mine; its author is a chiropractor by the name of SD White (I never met the man [surely it’s a man] and don’t know where he’s from):

Someone is suffering from a love of credentials (small penis?) and a sour disposition who has zero actual information about a profession of which he is not a member. So this is how you choose to spend your days? What a royal disappointment you must be to family, friends, and others with your extremely disjointed and disgruntled opinions. Which no one requested. Rating: 1/10

This type of hilarity encouraged me to write a post about chiropractic which fulfils some of SD White’s criteria: no one requested it, and it has zero actual information. But I hope it adds to the hilarity chiropractic so often creates.

The World Federation of Chiropractic supports the involvement of chiropractors in public health initiatives, particularly as it relates to musculoskeletal health. Three topics within public health have been identified that call for a renewed professional focus. These include healthy ageing; opioid misuse; and women’s, children’s, and adolescents’ health. The World Federation of Chiropractic aims to enable chiropractors to proactively participate in health promotion and prevention activities in these areas, through information dissemination and coordinated partnerships. Importantly, this work will align the chiropractic profession with the priorities of the World Health Organization. Successful engagement will support the role of chiropractors as valued partners within the broader healthcare system and contribute to the health and wellbeing of the communities they serve.

Passage from the paper:

The WFC’s Public Health Committee has committed to an expanded agenda that focuses on three new priority areas of public health: healthy ageing; opioid overuse and misuse; and women’s, children’s, and adolescents’ health. These were chosen for their alignment with WHO priorities, and the chiropractic profession’s ability to uniquely contribute to each through the lens of musculoskeletal health. The goal is to enhance the ability for chiropractors to actively engage in health promotion activities in alignment with WHO priority areas and pursue collaborative work to increase global attention on these important public health issues. As a first step, the WFC will focus on providing key strategies that chiropractors in primary care settings can focus on bridging their work in primary care and population health. The WFC has developed position statements and proposed public health strategies for each priority area, as described below.

The conclusion

The WFC commits to promoting and facilitating public health strategies for chiropractors to implement in practice. Healthy ageing, opioid misuse, and supporting women’s, children’s and adolescents’ health are priority areas of initial focus. This work builds on the shared goal of primary care and population health, through the prevention of illness, promoting health, improving patient care, and addressing contextual factors in a collaborative and evidence-based manner. Future work in public health for the chiropractic profession should also focus on broader roles such as community engagement and the creation of sustainable systems, engaging key stakeholders locally and globally.

The World Federation of Chiropractic supports the involvement of chiropractors in fleecing the public, particularly as it relates to musculoskeletal health. Three topics within chiropractic wealth have been identified that call for a boost in our cash flow. These include healthy ageing; opioid misuse; and women’s, children’s, and adolescents’ health. The World Federation of Chiropractic aims to enable chiropractors to proactively participate in misinforming the public in these areas, through coordinated partnerships with anyone who can be fooled. Importantly, this work will be camouflaged such that it seemingly aligns the chiropractic profession with the priorities of the World Health Organization. Successful engagement will support the wealth of chiropractors within the broader healthcare system but will contribute little to the health and wellbeing of the communities they pretend to serve.

Passage from the paper:

The WFC’s Public Health Committee has committed to an expanded agenda that focuses on three new priority areas for generating chiropractic wealth: healthy ageing; opioid overuse and misuse; and women’s, children’s, and adolescents’ health. These were chosen even though there is no good evidence to show that chiropractic might meaningfully contribute to any of them. The goal is to enhance the ability of chiropractors to actively engage in wealth creation activities in alignment with their financial aspirations. As a first step, the WFC will focus on providing key strategies that chiropractors in primary care settings can focus on for misleading the public. The WFC has developed position statements and proposed wealth strategies for each priority area, as described below.

The conclusion

The WFC commits to promoting and facilitating wealth strategies for chiropractors to implement in practice. Healthy ageing, opioid misuse, and supporting women’s, children’s and adolescents’ health are priority areas of initial focus. This work builds on many years of misleading the public into believing that chiropractors do more good than harm in any of these areas. Future work in generating wealth for the chiropractic profession should also focus on broader roles such as community engagement and the creation of sustainable systems, exploiting key stakeholders locally and globally.

Needle acupuncture in small children is controversial, not least because the evidence that it works is negative or weak, and because small children are unable to consent to the treatment. Yet it is recommended by some acupuncturists for infant colic. This, of course, begs the questions:

Does the best evidence tell us that acupuncture is effective for infant colic?

Are acupuncturists who recommend acupuncture for this condition responsible and ethical?

This systematic review and a blinding-test validation based on individual patient data from randomised controlled trials was aimed to assess its efficacy for treating infantile colic. Primary end-points were crying time at mid-treatment, at the end of treatment and at a 1-month follow-up. A 30-min mean difference (MD) in crying time between acupuncture and control was predefined as a clinically important difference. Pearson’s chi-squared test and the James and Bang indices were used to test the success of blinding of the outcome assessors [parents].

The investigators included three randomised controlled trials with data from 307 participants. Only one of the included trials obtained a successful blinding of the outcome assessors in both the acupuncture and control groups. The MD in crying time between acupuncture intervention and no acupuncture control was -24.9 min at mid-treatment, -11.4 min at the end of treatment and -11.8 min at the 4-week follow-up. The heterogeneity was negligible in all analyses. The statistically significant result at mid-treatment was lost when excluding the apparently unblinded study in a sensitivity analysis: MD -13.8 min. The registration of crying during treatment suggested more crying during acupuncture.

The authors concluded that percutaneous needle acupuncture treatments should not be recommended for infantile colic on a general basis.

The authors also provide this further comment: “Our blinding test validated IPD meta-analysis of minimal acupuncture treatments of infantile colic did not show clinically relevant effects in pain reduction as estimated by differences in crying time between needle acupuncture intervention and no acupuncture control. Analyses indicated that acupuncture treatment induced crying in many of the children. Caution should therefore be exercised in recommending potentially painful treatments with uncertain efficacy in infants. The studies are few, the analysis is made on small samples of individuals, and conclusions should be considered in this context. With this limitation in mind, our findings do not support the idea that percutaneous needle acupuncture should be recommended for treatment of infantile colic on a general basis.”

So, returning to the two questions that I listed above – what are the answers?

In the comment section of a recent post, we saw a classic example of the type of reasoning that many alternative practitioners seem to like. In order to offer a service to other practitioners, I will elaborate on it here. The reasoning roughly follows these simple 10 steps:

My treatment works.

My treatment requires a lot of skills, training and experience.

Most people fail to appreciate how subtle my treatment really is.

In fact, only few practitioners manage do it the way it has to be done.

The negative trials of my treatment are false-negative because they were conducted by incompetent practitioners.

In any case, for a whole range of reasons, my treatment cannot be pressed into the straight jacket of a clinical trial.

My treatment is therefore not supported by the type of evidence people who don’t understand it insist upon.

Therefore, we have to rely on the best evidence that is available to date.

And that clearly is the experience of therapists and patients.

So, the best evidence unquestionably confirms that my treatment works.

The case I mentioned above was that of an acupuncturist defending his beloved acupuncture. To a degree, the argument put forward by him sounded (to fellow acupuncturists) reasonable. On closer inspection, however, they seem far less so, perhaps even fallacious. If you are an acupuncturist, you will, of course, disagree with me. Therefore, I invite all acupuncturists to imagine a homeopath arguing in that way (which they often do). Would you still find the line of arguments reasonable?

And what, if you are a homeopath? Then I invite you to imagine that a crystal therapist argues in that way (which they often do). Would you still find the line of arguments reasonable?

And what, if you are a crystal therapist? …

I am not getting anywhere, am I?

To make my point, it might perhaps be best, if I created my very own therapy!

Here we go: it’s called ENERGY PRESERVATION THERAPY (EPT).

I have discovered, after studying ancient texts from various cultures, that the vital energy of our closest deceased relatives can be transferred by consuming their carbon molecules. The most hygienic way to achieve this is to have our deceased relatives cremated and consume their ashes afterwards. The cremation, storage of the ashes, as well as their preparation and regular consumption all have to be highly individualised, of course. But I am certain that this is the only way to preserve their vital force and transfer it to a living relative. The benefits of this treatment are instantly visible.

As it happens, I run special three-year (6 years part-time) courses at the RSM in London to teach other clinicians how exactly to do this. And I should warn you: they are neither cheap nor easy; we are talking of very skilled stuff here.

What! You doubt that my treatment works?

Doubt no more!

Here are 10 convincing arguments for it:

EPT works, I have 10 years of experience and seen hundreds of cases.

EPT requires a lot of skills, training and experience.

Most people fail to appreciate how subtle EPT really is.

In fact, only few practitioners manage do EPT the way it has to be done.

The negative trials of EPT are false-negative because they were conducted by incompetent practitioners.

In any case, for a whole range of reasons, EPT cannot be pressed into the straight jacket of a clinical trial.

EPT is therefore not supported by the type of evidence people who don’t understand it insist upon.

Therefore, we have to rely on the best evidence that is available to date.

And that clearly is the experience of therapists and patients.

So, the best evidence unquestionably confirms that EPT works.

Convinced?

No?

You do surprise me!

Why then are you convinced of the effectiveness of acupuncture, homeopathy, etc?

Currently, there are measles outbreaks almost everywhere. I have often pointed out that SCAM does not seem to be entirely innocent in this development. Now another study examined the relationship between SCAM-use and vaccination scepticism. Specifically, the researchers wanted to know whether a person’s more general health-related worldview might explain this relationship.

A cross-sectional online survey of adult Australians (N = 2697) included demographic, SCAM, and vaccination measures, as well as the holistic and magical health belief scales (HHB, MHB). HHB emphasises links between mind and body health, and the impact of general ‘wellness’ on specific ailments or resistance to disease, whilst MHB specifically taps ontological confusions and cognitive errors about health. SCAM and anti-vaccination were found to be linked primarily at the attitudinal level (r = -0.437). The researchers did not find evidence that this was due to SCAM practitioners influencing their clients. Applying a path-analytic approach, they found that individuals’ health worldview (HHB and MHB) accounted for a significant proportion (43.1%) of the covariance between SCAM and vaccination attitudes. MHB was by far the strongest predictor of both SCAM and vaccination attitudes in regressions including demographic predictors.

The researchers concluded that vaccination scepticism reflects part of a broader health worldview that discounts scientific knowledge in favour of magical or superstitious thinking. Therefore, persuasive messages reflecting this worldview may be more effective than fact-based campaigns in influencing vaccine sceptics.

Parents opposing vaccination of their kids are often fiercely determined. Numerous cases continue to make their way through the courts where parents oppose the vaccination of their children, often inspired by the views of both registered and unregistered health practitioners, including homeopaths and chiropractors. A recent article catalogued decisions by the courts in Australia, New Zealand, the UK and Canada. Most of them ruled in favour of vaccination and dismissed the arguments of those opposed to vaccination as unscientific. The author, an Australian barrister and Professor of Forensic Medicine, concluded that Australia should give serious consideration to emulating the model existing in multiple countries, including the United States, and should create a no-fault vaccination injury compensation scheme.

Such programs are based on the assumption that it is fair and reasonable that a community protected by a vaccination program accepts responsibility for and provides compensation in those rare instances where individuals are injured by it. To Me, this seems a prudent and ethical concept that should be considered everywhere.

Alternative practitioners practise highly diverse therapies. They seem to have nothing in common – except perhaps that ALL of them are allegedly stimulating our self-healing powers (and except that most proponents are latently or openly against vaccinations). And it is through these self-healing powers that the treatments in question cure anything and become a true panacea. When questioned what these incredible powers really are, most practitioners would (somewhat vaguely) name the immune system as the responsible mechanism. With this post, I intend to provide a short summary of the evidence on this issue:

Acupuncture: no good evidence to show stimulation of self-healing powers.

Aromatherapy: no good evidence to show stimulation of self-healing powers.

Bioresonance: no good evidence to show stimulation of self-healing powers.

Chiropractic: no good evidence to show stimulation of self-healing powers.

Detox: no good evidence to show stimulation of self-healing powers.

Energy healing: no good evidence to show stimulation of self-healing powers.

Feldenkrais: no good evidence to show stimulation of self-healing powers.

Gua sha: no good evidence to show stimulation of self-healing powers.

Herbal medicine: no good evidence to show stimulation of self-healing powers.

Homeopathy: no good evidence to show stimulation of self-healing powers.

Macrobiotics: no good evidence to show stimulation of self-healing powers.

Naturopathy: no good evidence to show stimulation of self-healing powers.

Osteopathy: no good evidence to show stimulation of self-healing powers.

Power bands: no good evidence to show stimulation of self-healing powers.

Reiki: no good evidence to show stimulation of self-healing powers.

Reflexology: no good evidence to show stimulation of self-healing powers.

Shiatsu: no good evidence to show stimulation of self-healing powers.

Tai chi: no good evidence to show stimulation of self-healing powers.

TCM: no good evidence to show stimulation of self-healing powers.

Vibrational therapy: no good evidence to show stimulation of self-healing powers.

Vaccinations: very good evidence to show stimulation of self-healing powers.

Why do most alternative practitioners show such dogged determination not to change their view of the efficacy of their therapy, even if good evidence shows that it is a placebo? This is the question that I have been pondering for some time. I have seen many doctors change their mind about this or that treatment in the light of new evidence. In fact, I have not seen one who has not done so at some stage. Yet I have never seen an alternative therapist change his/her mind about his/her alternative therapy. Why is that?

You might say that the answers are obvious:

because they have heavily invested in their therapy, both emotionally and financially;

because their therapy has ‘stood the test of time’;

because they believe what they were taught;

because they are deluded, not very bright, etc.;

because they need to earn a living.

All of these reasons may apply. But do they really tell the whole story? While contemplating about this question, I thought of something that had previously not been entirely clear to me: they simply KNOW that the evidence MUST be wrong.

Let me try to explain.

Consider an acupuncturist (I could have chosen almost any other type of alternative practitioner) who has many years of experience. He has grown to be a well-respected expert in the world of acupuncture. He sits on various committees and has advised important institutions. He knows the literature and has treated thousands of patients.

This experience has taught him one thing for sure: his patients do benefit from his treatment. He has seen it happening too many times; it cannot be a coincidence. Acupuncture works, no question about it.

And this is also what the studies tell him. Even the most sceptical scientist cannot deny the fact that patients do get better after acupuncture. So, what is the problem?

The problem is that sceptics say that this is due to a placebo effect, and many studies seem to confirm this to be true. Yet, our acupuncturist completely dismisses the placebo explanation.

Why?

Because he has heavily invested in their therapy? Perhaps.

Because acupuncture has ‘stood the test of time’? Perhaps.

Because he believes what he has been taught? Perhaps.

Because he is deluded, not very bright, etc.? Perhaps.

Because he needs to earn a living? Perhaps.

But there is something else.

He has only ever treated his patients with acupuncture. He has therefore no experience of real medicine, or other therapeutic options. He has no perspective. Therefore, he does not know that patients often get better, even if they receive an ineffective treatment, even if they receive no treatment, and even if they receive a harmful treatment. Every improvement he notes in his patients, he relates to his acupuncture. Our acupuncturist never had the opportunity to learn to doubt cause and effect in his clinical routine. He never had to question the benefits of acupuncture. He never had to select from a pool of therapies the optimal one, because he only ever used acupuncture.

It is this lack of experience that never led him to think critically about acupuncture. He is in a similar situation as physicians were 200 years ago; they only (mainly) had blood-letting, and because some patients improved with it, they had no reason to doubt it. He only ever saw his successes (not that all his patients improved, but those who did not, did not return). He simply KNOWS that acupuncture works, because his own, very limited experience never forced him to consider anything else. And because he KNOWS, the evidence that does not agree with his knowledge MUST be wrong.

I am of course exaggerating and simplifying in order to make a point. And please don’t get me wrong.

I am not saying that doctors cannot be stubborn. And I am not saying that all alternative practitioners have such limited experience and are unable to change their mind in the light of new evidence. However, I am trying to say that many alternative practitioners have a limited perspective and therefore find it impossible to be critical about their own practice.

If I am right, there would be an easy (and entirely alternative) cure to remedy this situation. We should sent our acupuncturist to a homeopath (or any other alternative practitioner whose practice he assumes to be entirely bogus) and ask him to watch what kind of therapeutic success the homeopath is generating. The acupuncturist would soon see that it is very similar to his own. He would then have the choice to agree that highly diluted homeopathic remedies are effective in curing illness, or that the homeopath relies on the same phenomenon as his own practice: placebo.